Re:Patient Require your help!!!!
Sep 26, 2010
Hi, doctor My name is D A. I am doctor internal medicine,MD from New Jersey. My patient asked you question bunch of time but he didnt receive any response. He insisted that i asked you this question. The patient is very close relative. Here is list of lab test results:
(Lab Corp)July 09, ICMA HIV 1/O/2, test positive, western blot negative. Viral load undetectable
(Quest Diagnostics)October 09, EIA test negative, western blot negative.
(Lab Corp)January 2010, ICMA test positive(3.33) western blot negative. Viral load undetectable
(Quest Diagnostics)March 2010, EIA test Non-reactive. CD 4 count 732, Percentage 32. CD 8 count 764 percetage 36. ratio is 0.92.
(Lab Corp)March 2010, ICMA test reactive 1.85, western blot negative. Viral load undetactable. cd 4 count is 674 percentage 29.9, cd 8 count 819 percentage 34.4 ratio is 0.81.
(Quest Diagnostics)April 2010, EIA non-Reactive, western blot negative.
(Lab Corp)August 2010, ICMA HIV 1/O/2 reactive, western blot negative. cd 4 count 592 percentage 29.9 cd 8 count 838 percentage 39.9. their ratio is 0.71
My knowledge is limited on this subject. I am assuming that he is negative but I cant be sure. I am seeking your help. One thing I dont understand is that why he is negative with quest diagnostics but positive tith lab corp. also if he is negative then why his cd 4 count is going low and low. does this indicated very rare strain of virus such as group o. My patient is going through tremendous anxiety..I hope to hear from you soon. Thanks!!!
Response from Dr. McGowan
Sorry I did not see the question before...
I agree that the results indicate that he is not infected with HIV-1.
One possibility is that your patient is infected with HIV-2. Usually the EIA shoud be reactive for 1/2, not sure why the Quest test would not be reactive. Generally the lab will reflexibly send this out for HIV -2 testing...was this done? If not it should be requested.
Rare cases of Group N or O may be possible if your patient traveled to or had sexual contact with a person from Cameroon, Benin, and other Central African countries. Outside of this contact it would be extremely rare. New HIV Rapid tests (such as Abbott Determine HIV 1/2 can detect virtaully all Group O positives).
Cross reacting antibodies can lead to one test being repeatedly positive with the other being negative....the lack of any bands on the Western blot would favor it being a false positive.
Hi, doctor I as doctor am very concern because patient is my nephew. He did tested for HIV EIA 2 and it was undetectable...Thanks
Response from Dr. McGowan
That is good news. It really puts HIV out of the issue.
The CD4 count should always be measured in the same lab since there are cross-lab differences. That would explain the difference between the Quest CD4 measure and the ones at Labcorp. Note that, although the CD4 absolute count changes bewteen the 2 values, the CD4% does not. This reflects the variation from day to day in CD4 counts (which measured in the blood while most CD4 cells move in and out of tissues).
I would be reassured that HIV was not behind these lab measurement issues. Best, Joe
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